OTC Pain Relief: NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are over-the-counter medications that can be used to reduce fever, relieve mild aches and pains, and reduce inflammation. Learn how these pain relievers work and how to take them safely.

When you’re in pain, it’s natural to want relief. Whether you’re suffering from arthritis, menstrual cramps, or a pulled muscle, over-the-counter (OTC) pain relievers can ease your aches and help you get on with your life. But like all medicines, OTC pain relievers can cause side effects and may not be safe for everyone.

“Many people assume that because these drugs are sold over the counter that they are completely safe and totally benign,” says Elliott Antman, MD, professor of medicine at Harvard Medical School and Brigham and Woman’s Hospital in Boston. “But they can also have consequences that are important to understand.”

So before you reach for one of the many bottles on the drugstore shelf, read on to learn about one type of OTC pain relievers -- non-steroidal anti-inflammatory drugs (NSAIDs) -- and the benefits and risks of taking them.

How Do NSAIDs Relieve Pain?

NSAIDs are one of two major types of OTC pain relievers. The other is acetaminophen (Tylenol).

A few different types of NSAIDs are available over the counter:

  • Aspirin (Bayer, Bufferin, Excedrin)
  • Ibuprofen (Advil, Motrin IB)
  • Naproxen (Aleve)

Stronger doses of some of these drugs, as well as other NSAIDs, are also available by prescription.

NSAIDs are used to reduce fever and relieve mild aches and pains.They can be used for everything from a mild toothache or headache to cramps. Many people also use NSAIDs to relieve the pain of arthritis or to treat the aches and pains of the common cold and flu.

NSAIDs work by blocking enzymes in the body that help make chemicals that signal pain. When these enzymes are blocked, you feel less pain.

Side Effects of NSAIDs

Like any drug, NSAIDs can have side effects. The side effects can vary a bit from drug to drug, but most commonly include:

  • Stomach upset or nausea
  • Stomach pain
  • Heartburn
  • Diarrhea

Less common but potentially serious side effects of NSAIDs include:

  • Stomach ulcer and bleeding
  • Increased blood pressure
  • Allergic reaction -- hives, facial swelling, asthma/wheezing

Some people may be at higher risk for side effects or other problems with NSAIDs. Talk with you doctor before taking any NSAID if you:

  • Are over age 60
  • Are pregnant or nursing
  • Have three or more drinks of alcohol every day
  • Have bleeding problems
  • Have liver or kidney disease
  • Have heart disease
  • Take a medicine to thin the blood, such as warfarin (Coumadin)
  • Take a medicine for high blood pressure

Children and teenagers who are recovering from a viral infection such as the flu or chickenpox should not take aspirin. It has been linked to Reye’s syndrome, a serious but rare condition that can result in brain, kidney, and liver damage. Naproxen sodium is not recommended for children under 2. Ibuprofen is considered safe for children 6 months and older in the right dose.

NSAIDs and Heart Risk

Because NSAIDs can affect blood pressure and blood clotting, they can also put you at risk for heart problems and stroke if you use more than directed or for longer than directed. Generally, people who have risk factors for heart disease may be at greater risk for having serious cardiovascular problems, such as strokes and heart attacks, from NSAID use.

When it comes to choosing and using NSAIDs, Antman offers this advice: “Generally, your best option is to take the least risky drug, at the lowest dose you need to control your pain, for the shortest amount of time possible.”

How you choose the least risky drug for you may depend largely on your personal health risks.

“Since each person’s medical situation is different, you should talk with your doctor if you have any questions about taking NSAIDs,” says Joel Schiffenbauer, MD, deputy director of the Division of Nonprescription Clinical Evaluation at the FDA Center for Drug Evaluation and Research.

Although taking some NSAIDs may increase the risk of heart problems, aspirin is given to many heart patients in low doses to help protect against heart attack and stroke. If you are taking aspirin to prevent a heart attack, talk to your doctor before taking another NSAID at the same time. It may interfere with the beneficial effects of the aspirin.

NSAIDs can also increase blood pressure, particularly if you already have high blood pressure. If you have high blood pressure or are taking medicine to lower blood pressure, talk to your doctor to see which OTC pain reliever is right for you.

NSAIDs and Stomach Problems

The most common side effect of NSAIDs is stomach problems, including upset stomach, nausea, and heartburn. Stomach ulcers and bleeding can also occur with long-term use. Your risk of having a stomach problem increases the more often you take NSAIDs and the longer you take them. Seniors are at a greater risk of stomach problems from NSAIDs.

To reduce your risk of problems with NSAIDs, try these tips:

  • Don’t drink alcohol. Drinking alcohol while you’re taking an NSAID increases your risk of bleeding.
  • Take NSAIDs with food and water.
  • If you have a history of stomach problems, ask your doctor about taking a drug that blocks stomach acid with the NSAID.

How we experience pain and the amount of pain relief we get from NSAIDs varies from person to person. When choosing pain relief medication, it’s most important to take the lowest dose that works for you and to take it as directed. And if your pain continues for more than a 10 days or isn’t controlled by the NSAID, it’s a good idea to talk with your doctor.

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